ClickCare Café

Is an In-Person Visit Always Preferable to Telehealth Options?

Posted by Lawrence Kerr on Thu, Oct 11, 2018 @ 06:00 AM

rawpixel-743067-unsplashA new article in the New England Journal of Medicine takes a controversial stance on the topic of whether an in-person doctor's visit is always "Plan A."

Perhaps, the author argues, we are moving towards a time when patients will be better served by a model in which in-person visits are actually the "last resort" of care. 

Our take? Yes and no. Read on...

In "In-Person Health Care as Option B", Sean Duffy and Dr. Thomas H. Lee advocate for a new framework for healthcare visits. Rather than seeing telehealth visits or other virtual options as "in the meantime" approaches or ways to cut costs, they argue that perhaps patients can be cared for better when in-person visits become much rarer, only used when absolutely necessary.   

They describe the analogy of a tech support ticketing system, as might be used at your favorite software company. Perhaps a patient would submit a "ticket" with their concern or medical issue... it would be handled first via telehealth means (even automated or low level support at first)... only being "escalated" to an in-person visit if absolutely necessary. And the ticket wouldn't be closed out until or unless the initial complaint was resolved.

The technology is there, the authors contend. “Smartphone penetration of the mobile-phone market increased from 17% to 81% between 2009 and 2016.” And the reality is that in many ways, our medical system is already moving in this direction: "At Kaiser Permanente, for example, 52% of the more than 100 million patient encounters each year are now “virtual visits.”

One important point that the authors make is that doctors are often approaching care this way currently -- but with improvised methods that aren't really meeting the provider's or the patient's needs. True enough: “Virtual visits are more convenient, but there’s a difference between recreating an in-person approach with digital tools and designing the safest and most efficient way to achieve an optimal outcome." Further, if doctors are simply using text messaging, email, or informal photos to replace a visit, that's not a safe or sustainable way to replace the richness and HIPAA-compliance of a real visit. Also, improvised approaches tend to be lesser replacements for in-person care, rather than innovative ways to save money AND get a better result.

Although we agree that there is a lot of potential to rethink how we approach clinical visits in healthcare, we also worry that the authors' approach isn't appreciating some of what can be lost if telehealth approaches aren't designed thoughtfully.

For instance, the example of the tech support "ticketing" analogy would fall severely short of our goals for any medical visit. Sure, the patient's complaint needs to be addressed. But medicine is more complex than software.

So any approach to increasing the use of telehealth solutions also must:

  • Support medical education.
    This means that simple videoconferencing or "e-visits" likely aren't sufficient, as they don't create an archivable, searchable, teachable record of the encounter.

  • Provide holistic care to the patient. 
    Support not just solving the immediate problem, but truly caring for the patient -- which doesn’t always just mean solving only the problem the patient presents with.

  • Enable providers to collaborate effectively.
    It would be a tragedy if telehealth caused a further silo-ing of providers across specialities and across the continuum of care.

Healthcare needs innovation, certainly. And technology will be a crucial part of any solution that stands a chance of survival moving forward. But we advocate for approaches that truly support access, education, and collaboration -- not just completing a ticket and checking off a box for a patient.

 

To learn more about alternative technologies for telehealth, download our Quick Guide to Hybrid Store and Forward Telemedicine®: 

 

ClickCare Quick Guide to Hybrid Store-and-Forward

 

 

Tags: hybrid store and forward medical collaboration, telehealth and hipaa

3 Things We Learned About Healthcare Collaboration From a Shocker of a Story

Posted by Lawrence Kerr on Thu, Oct 04, 2018 @ 06:00 AM

ani-kolleshi-640938-unsplashSometimes, healthcare collaboration can sound mundane.

It sounds like a bit of a “flourish” — something that’s ideal to do if we have time, but not crucial to the care we give. I think many providers picture it as useful for “double checking” a diagnosis or getting some second-level insight.

But a recent story in the New York Times shows that a lack of healthcare collaboration can have permanent impacts on our patients’ lives. And that what we can get from healthcare collaboration is far from basic — it’s crucial to the fundamental care we give.

A six-year-old boy in Texas, called Mason Motz, has been nonverbal his whole life. His parents believed that it came from a stroke he had when he was 10 days old. And while he could speak at the level of a one-year-old for his entire life, he had never been able to communicate much beyond beginnings of basic words — a kind of communication that only his parents could understand.

In the last few years, Mason started going to a dentist that focuses on care for kids with special needs. His dentist, Dr. Amy Luedemann-Lazar, started with some basic procedures, getting to know Mason over the course of many visits, and making sure he felt comfortable at the office.

In April, Dr. Luedemann-Lazar was performing an unrelated procedure and realized that the band under his tongue was shorter than normal — he was tongue-tied. She dashed to the waiting room and got permission from the Motzes to do the corrective procedure. She was able to perform the procedure in 10 seconds, with a laser — and within hours, Mason was talking dramatically more understandably than before.

We know that there is controversy about the detrimental effects of ankyloglossia as noted in the article and even about the technique of repair, but in this case at this age, it was clearly an appropriate avenue to go down. Mason has a road of speech therapy ahead but is expected to be caught up to his peers’ speaking ability by age 13.

While this is certainly a simple story of a medical provider who really got things right, we think that the story also holds some lessons about healthcare collaboration that are important to capture.

 

3 Things We Learned About Healthcare Collaboration from this Story:

  • When providers from different specialties aren’t part of the conversation, huge mistakes happen.
    Although Dr. Luedemann-Lazar made a tremendous diagnosis, we still regret that the insight didn't happen when Mason was still a baby. On our interdisciplinary Cleft & Cranio-facial team, we treated children with cleft palates and cleft lips -- and the team included dentists, teachers, social workers, plastic surgeons and others. This meant that foundational insights from one specialty didn't get missed in care from a different specialty. 

  • Relationships with our patients allow insights.
    In this story, I found it interesting that the dental practice that Mason had been going to specialized in caring for patients with special needs -- and that part of what they do is develop trusting relationships with their patients. I believe this approach may have played a role in facilitating the diagnosis -- without the background relationship, it's possible that the dentist wouldn't have noticed the issue. Healthcare collaboration enables doctors to have stronger, more holistic relationships with their patients. Rather than the constant handoffs, the team approach to care means that the patient and who they are as a person is front-and-center.

  • Sophisticated insights don’t always mean complicated interventions.
    Often, telemedicine and medical collaboration are conflated with fancy interventions and high-flying specialists. But as this story shows, crucial insights don't always mean complicated interventions (in this case, it was a 10-second cut with a laser.) 

 

We certainly applaud Mason's parents for hanging in there, and getting him the support he needed as soon as it was available -- and we hope that Mason's dentist gave herself a good pat on the back at the end of that day. We also know that these simple miracles of healthcare collaboration happen every day -- and for many creative and caring providers, it's a matter of the routine magic they make happen. 

 

For more stories of medical collaboration, download our quick guide: 

ClickCare Quick Guide to Medical Collaboration

 

Why Overall Well-Being is as Important as Medical Intervention for Cost Savings

Posted by Lawrence Kerr on Tue, Oct 02, 2018 @ 06:00 AM

rawpixel-678092-unsplashHealthcare is such a potent combination of art, science, social work, and hard economics. And where these varying approaches touch each other, there can be friction.

So many healthcare providers view what they do as a combination of art, science, and social work — with hard economics never (or rarely) entering their mind.

But many times, healthcare economists come from a perspective that assumes something very different about how healthcare functions and how providers make decisions. Many times, healthcare economists use as a fundamental premise the idea that: providers are self-interested and will bill for as many services as they can; and it’s crucial to focus on hard outcomes of services, not on overall well-being of patients. Their perspective tends to be that hard economics reign and that these other approaches are dreamy intangibles.

A new study in JAMA challenges all of that.

JAMA published a study described as a “US national, population-based cross-sectional study [examining] the association between county well-being and Medicare fee-for-service (FFS) spending.”

In other words, researchers looked at whether Medicare spending was lower when people’s overall (non-medical) well-being was better. The results?  Medicare spent almost $1,000 less per patient for those in the 20% of well-being scores, compared to the bottom. And this is after adjusting for independent factors like income, urbanity, educational level, etc.

As the JAMA study explained, “Well-being is a positive state of being beyond the absence of disease, measured by not only physical health but also other dimensions, such as emotional, social, and economic health. Well-being may be modifiable by a broad range of interventions across different sectors.”  It’s all the stuff that we tend to see as “outside the scope” of a given medical intervention.

We think this is an incredibly important insight and study highlighting something not commonly spotlighted. Certainly, new models have gone up one level to reward fee-for-performance rather than fee-for-service. But the truth is that this measure of overall well-being is up several levels beyond that. And to capture the economic value of our patient's overall health and happiness is important. 

The whole goal of what we do as doctors is to support our patient’s well-being. But if you really needed another reason to pursue that measure, this is evidence that a broader view, a more holistic approach, is cost-effective too.

One of the challenges that we get into with iClickCare utilization is that it might be more efficient to just allow secure text-messaging, rather than having a fulsome, team-based, archivable healthcare collaboration system. The very reason we do what we do is because we believe that this kind of more holistic, team-based approach may not be the fastest way to get a simple, discrete answer — but it is the most efficient, effective, and cost-conscious way of approaching the whole patient. The "whole patient" includes all aspects of their medical condition as well as the other factors in their life that interrelate with that condition. 

The components of well-being in the study that decreased cost-per-patient so dramatically were largely non-medical. That means that any collaboration system that doesn’t allow non-medical caregivers and providers (social workers, teachers, caregivers, etc) to collaborate is misguided and ultimately wasteful in terms of ROI. 

We're glad that this kind of study is being done. And we continue to applaud the efforts of all of those healthcare providers who take the holistic view of their patient's well-being -- rather than simply addressing the malady in front of them. 

 

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Tags: healthcare collaboration, medical collaboration, care coordination

5 Reasons Bundled Payment Programs May Not Be a Silver Bullet

Posted by Lawrence Kerr on Thu, Sep 27, 2018 @ 06:00 AM

jordan-rowland-716475-unsplashMost healthcare providers let “innovations around reimbursement” come and go.

The majority of us — whether we’re aides, nurses, specialists, or generalists — try to provide the best care possible, in as reasonable a way as possible. And we let the reimbursement and payment fall however it does, after the fact.

That said, there are certainly big shifts that affect how we care for patients — and certainly how we’re paid to do so. And “bundled payments” are one of those shifts that are big enough to pay attention to.

A New York Times article did a thoughtful review recently of Medicare’s bundled payments programs. Currently, these programs are effectively pilots, with hospitals able to opt into the program, rather than making them mandatory.

As I’m sure you’re aware, bundled payment programs create a single payment for every health care service associated with an event. (Rather than paying for the healthcare services individually.) The idea, of course, is that this approach would decrease costs: “In theory, if doctors and hospitals get one payment encompassing all this, they will better coordinate their efforts to limit waste and keep costs down.”

Of course, anyone who has ever gotten a “meal deal” because it was a better value — even though they weren’t originally planing on buying chips or a drink — understands why this may not be the best idea.

That said, some data shows that at least for hip and knee replacements, overall costs are slightly lower than with fee-for-service models. But different types of healthcare are different. And data on hip and knee replacements may not relate at all to other areas of healthcare — especially when the data is coming entirely from hospitals who have opted into the program (rather than taking part in it mandatorily.

But we have some broader concerns about programs like bundled payments.

5 Reasons Bundled Payment Programs May Not Be a Silver Bullet:

  • Most waste isn’t coming from doctors pursuing profit over smart care.
    One core concept in the formulation of this type of program is that providers are seeking profit first and safe, considerate care second. My honest take? This happens, but not very often. And so it's possible that one of the framing ideas is false.
  • Savings from bundled payments necessitate collaboration — and collaboration needs tools.
    Bundled payments benefit greatly from collaboration that can be empowered by healthcare collaboration tools like iClickCare. But simply changing how things are paid for may not provide the tools necessary to make that collaboration -- and thus the savings -- possible.
  • Savings from bundled payments necessitate care coordination — and care coordination demands support.
    This type of integrated payment depends on the interdependency of the providers. As with healthcare collaboration, however, providers are often attempting to coordinate care against all odds. And so it may make more sense to make care coordination more effortless than simply to change payment structures.
  • The “bundle” might not be the right combination of services.
    The bundling structure assumes that it is known what’s needed for a given healthcare event. The reality?  Healthcare “events” can be unpredictable and complex -- every patient is different.
  • Savings are good but rationing usually isn’t.
    The author of the Times article makes a point about steering patient access. While it certainly makes sense to guide patients towards the most appropriate treatments, I worry that this structure can raise the spectre of rationing -- which usually means that people with the least resources end up getting the worst care. Plus, in these programs, quality is generally not taken into account, at least not in very sophisticated ways — especially tracking quality across different groups.

 

All of the above isn’t to say that an overall shift to value-based care isn’t desirable (plus, it’s likely inevitable.) But we do think that it’s important to advocate for supports for shifts in care and reimbursement — not just change how doctors are paid.

 

Looking for ways to save costs in your hospital system? Hybrid Store-and-Forward may be the simplest way towards great ROI: 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: value based care, healthcare collaboration, care coordination

The Best Way to Help Young Patients? Get Them Back to Playing Faster

Posted by Lawrence Kerr on Thu, Sep 20, 2018 @ 06:00 AM

jelleke-vanooteghem-578746-unsplashAs you probably know, our cofounder is a pediatrician.

As someone who has treated children across socioeconomic groups for decades, she found that having a playhouse in the waiting room created a sense of normalcy, fun, and respect for the children she saw. She found that patients looked forward to their visits, since they could play in the playhouse -- and parents had a few unexpected moments of respite.

Of course, that was just one detail out of thousands as to how she cares for children in ways that are deeply effective and respectful of who they are as children -- but it highlights the ways that play are important in medicine.

Perhaps it’s eye-rollingly obvious, then, that the American Academy of Pediatrics would release a statement affirming the role of play in children’s lives. Perhaps their suggestion that doctors need to write a “prescription for play” is a good one.

But I also wonder whether, as healthcare providers, we should think less about prescribing play to parents who are already likely doing the best they can. And we should think more about how we, and the medical system, can get out of the way so that our patients can get back to play and learning.

Children have important work to do — learning and playing being two big parts of it. And one part of the tragedy of sickness — and the hospital stays, doctors' visits and long car rides that accompany it — is that children are removed from that important work of play. If play is so important, it’s crucial for our pediatric patients that we limit time in the hospital so they can spend more time “doing the work of childhood”

Sometimes the simplest solution is the most effective. In fact, I was reminded of this story of a terminally ill 2-year-old who loves Christmas. Realizing that he wasn't going to live until December 25th, his parents decided to recreate Christmas early that year. His neighbors, hearing the idea, decided to join suit. So the little boy's neighborhood became filled with lights, decorations, good cheer, gifts, and even a Christmas parade, even though it's only September. 

To me, allowing children to get back to play means different things in different situations -- sometimes a playhouse; sometimes a neighborhood teaming up for Christmas. But most of the time, in a medical setting, it means that we are doing care coordination and healthcare collaboration effectively enough that our young patients are spending less time in the doctor's office, waiting room, car-ride, and hospital. That means coordinating care so they can be released from the hospital 6 hours sooner. It means a team approach to care so that they're not bouncing from doctor's visit to doctor's visit with no resolution. It means using telemedicine to get a consult so that the child doesn't need to leave school to see yet another specialist. It means school-based health centers (linked to specialists by telemedicine) so that kids can get healthcare during the school day. 

Our view as providers must be broad enough to include an understanding of care that isn't simply about curing disease -- but about cultivating health in our patients (young and old). And that starts with getting patients back to their lives as quickly as possible. 

For stories of how medical collaboration can work in the real world, download our Quick Guide: 

ClickCare Quick Guide to Medical Collaboration

Tags: healthcare collaboration, care coordination, good medicine

Medical Education Fails to Prep Doctors to Care for Addiction

Posted by Lawrence Kerr on Tue, Sep 18, 2018 @ 07:00 AM

joshua-ness-225844-unsplashAs we’ve written about recently, the opioid epidemic is at staggering levels, and touching millions of lives every year in the US.

While these are complex cases, the truth is that treating addiction is not something that exists as distinct from treating any patient — since any patient can experience addiction. And a recent article in the New York Times put a spotlight on how our medical education may be failing to prepare doctors effectively to treat patients with addiction. 

The doctors, professors, and administrators in our medical education system are incredibly dedicated, and manage to adapt to a rapidly changing healthcare system. Some of the most satisfying work in my career has been my work with medical students and residents.

That said, there are always components of medical education that feel neglected, whether that's nutrition or alternative medicine. The care and treatment of addicted patients is no different, except for the staggering scale of the problem. In fact, addiction is contributing to 623,000 deaths each year in the US. And a new article explores whether our medical training is contributing to the shortcomings in how we care for these patients.

Realistically, the article documents what we're all aware of -- it's uncommon that there is sufficient training or support for doctors in caring for addicted patients. Most medical schools offer some training about opioids, but they rarely go very deep. New initiatives are aiming to create fellowships in addiction medicine -- but more trained fellows won't help the myriad of patients seeing providers in other fields who need solid training in how to care for them. But we also felt that some important perspectives were being left out of the conversation as represented in this article and the common ways of thinking about treating addicted patients.

5 things we know for sure about medical education and the treatment of addicted patients:

  • Medical education can’t stop at graduation.
    It concerns us that the conversation about education around caring for addicted patients is understood to be limited to medical school. In contrast, we've always had three core principles at ClickCare: access, collaboration, and education. We've baked education into every single aspect of how iClickCare works, since we believe that medical education should be a lifetime goal -- both as teachers and as students. The opioid epidemic is changing rapidly over time and so our medical education has to keep up -- it can't get stuck in decades-old coursework. Allowing teams to archive and search cases for education (using a tool like iClickCare) is crucial to this process.

  • "Problem patients" are everyone's problem. 
    All healthcare providers face different pressures. But we believe that when you decide to become a doctor, we believe that it's no longer ethical to see complex patients or cases as "not my problem." One of the suggested solutions to the training gap is to create "addiction medicine" specialists rather than increasing training around addiction for all doctors. Is specializing in addiction really the way to go?  Perhaps, all that does is let the rest of us off the hook for a very human dynamic that can happen to any patient and that we all need to be able to treat and recognize.

  • We must teach each other.
    We have different strengths and weaknesses. And in an increasingly complex medical setting, trusted collaboration and complementarity is crucial. The care and treatment of addicted patients is a great example of why healthcare collaboration -- whether supported by Hybrid Store-and-Forward telemedicine or through another means -- is so important.

  • Chronic diseases need special treatment.
    Addiction, like Diabetes, is a chronic disease. And patients suffering from chronic diseases need true care coordination, long-term collaboration within an integrated care team, and a truly team approach to their care. Addicted patients are no different, and we must find ways -- together -- of treating them as effectively as any other patient.

  • There must be space for ambiguity. 
    As the New York Times article says, “although medical training typically urges students to come up with absolute answers, treating these patients often means getting comfortable with ambiguity.” Addiction is a delicate, nuanced challenge that requires providers to be able to handle ambiguity at an emotional and an intellectual level. That said, out tools must also be able to support and handle ambiguity. Rather than a text message which demands a succinct answer, telemedicine-supported medical collaboration allows more space for ambiguity because there is more space for nuanced conversations. Photos, videos, complex conversations, and multidisciplinary teams are all components of supporting complex care for complex cases. 

We know that many of you are "on the frontlines" of caring for patients with addiction every day. And we certainly hope that you're able to find the tools you need to evolve as a healthcare provider within that -- teaching, learning, and caring for patients.

 

To learn more about Hybrid Store-and-Forward® telemedicine, download our white paper for free:

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: healthcare collaboration, hybrid store and forward medical collaboration, medical education

Surprising Study Shows Doctor’s Race Crucial in Health Outcomes

Posted by Lawrence Kerr on Wed, Sep 12, 2018 @ 07:00 AM

rawpixel-744343-unsplash

Black men have the lowest life expectancy of any ethnic group in the United States. Chronic disease — like diabetes and hypertension — play a big role. But the path to reducing rates of those maladies can seem unclear.

A new study by researchers in California showed a shocking finding in one parameter that could dramatically influence outcomes — the race of the doctor. 

The study itself was pretty simple and looked at the likelihood of patients to accept preventative measures, comparing the likelihood with a white doctor and with a black doctor. The study participants were 702 black men in Oakland, California, who came to a clinic for a free health screening. They were randomly assigned to a black male doctor or one who was white or Asian.

The results were pretty stark (as elucidated by The New York Times):

— 63 percent of the black men assigned to a black doctor agreed to a diabetes screening. Just 43 percent of those assigned to a doctor who was white or Asian consented to be screened.
— Some 62 percent of black men with a black doctor agreed to cholesterol tests, compared to 36 percent assigned to a doctor who was not black.

These rates might not sound world-changing, but the consequences of them are. If black patients were to agree to preventive care at these rates in the real world, researchers estimate that the gap in cardiovascular mortality between black men and the rest of the population could be reduced by 20 percent.

So was it the race of the provider itself that made the difference? Or was it something that black doctors were doing differently, or more effectively, than the white doctors?

There’s no hard evidence to answer that question, but one telling component of the findings are the comments written by both patients and doctors in the study. Black patients had equally positive comments of doctors, regardless of their race. But of black doctors, their comments skewed more emotional and effusive. Similarly, the notes on  the white doctors tended to be shorter and dryer. Black doctors’ notes were more detailed and more holistic, including comments on elements of the patient’s experience and overall life.

One of the black doctors in the study really affirmed that ultimately, it’s not about race — it’s about good care. “It’s something they don’t teach you in medical school — taking that extra step because you appreciate there have been barriers in the past,” Dr. ChaRandle Jordan said, saying that white doctors can reach out just as well and that a lot depends on how familiar a doctor is with black patients.

From our perspective, there are several key implications of this study for our work with medical collaboration and care coordination:

— A team approach is important. Sometimes the background of the provider can make a difference, and where that's true, having a diverse team working together closely, is a key asset. 

— Good care is about more than the facts. Simply offering the appropriate preventative screening isn't enough. In this study, it appears that the black doctors' efforts to build rapport and even to push back on patients' initial reticence were a big part of their good outcomes. Having the perspective and tools to work with a more holistic sense of the patient is key.

Obviously, we believe that great care can happen among providers and patients of any race. But looking at race and differences in engagement and interaction shouldn't be taboo. We often say that "no one of us is a smart as all of us."  And this is one more example of how our colleagues down the hall may have a lot to teach us — if we are open to learning. 

For stories of medical collaboration, download our Quick Guide: 

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, care coordination, good medicine

Can Your Leadership Style Survive the New Healthcare Reality?

Posted by Lawrence Kerr on Fri, Sep 07, 2018 @ 07:00 AM

rawpixel-668353-unsplashMedicine tends to feel like ground shifting underneath our feet, most days. Each day brings new challenges (and perhaps new opportunities) -- and as healthcare providers, we're left trying to find our footing.

One key shift is that as medicine becomes more regulated and “bigger business”, healthcare providers set the agenda less — and increasingly must adapt to the agenda being set by the rest of the healthcare system.

For instance, in the shift to value-based care, so much about how we measure success and how we look at our goals, team, and even income, is changing. All of these changes can leave doctors and hospital administrators -- often seen as the "leaders" in medicine -- playing catchup. For anyone who is, or who sees themselves as, a leader in medicine, the nature of their work is shifting from one type of leadership to another type of leadership, altogether.

As this article in the New England Journal of Medicine Catalyst affirms, these changes require leaders to develop new skill sets.“This transformation is driven by a shift from fee-for-service models, which reward volume of care delivered (e.g., quantity of procedures, tests, and relative value units) when patients get sick and need care, toward value-based care models, which reward high quality and excellent health outcomes delivered through careful deployment of resources to keep populations healthy.” In fact, the author lays out four key types of leaders in medicine that are particularly catalytic and important in any organization -- or provider -- thriving in this new setting. 

These archetypes certainly resonate with our experience in medicine as key to surviving and thriving in this new setting. But the truth is that no leader exists in a vacuum. Great leaders need great teams and exceptional tools. And so today, we look at these 4 leadership styles and how they can be supported by the right team approach and the right tools. 

4 leadership styles that will succeed in the new value-based healthcare system and why they need the right tools:

1. Community Connector

As we share frequently in this blog, the New England Journal article affirms that, “60% of the factors that influence health status are outside the control of our legacy health care systems in the forms of social, behavioral, and environmental circumstances." So their first leadership style is one that can connect with the people, organizations, and resources that relate to these circumstances.

We actually think that integrating these non-medical factors is foundational to good care, and that connecting these dots should be an everyday part of your care. It's not always easy to connect these dots however -- it becomes crucial to have a healthcare collaboration tool that allows you to connect with the people on your team who can bring these additional perspectives. For instance, the teacher, social worker, WOCN, they all tend to bring in more of the “unconventional” aspects of care that we know are just as crucial as the surgery or office visit. Just be sure that the tool you use is asynchronous -- meaning folks can respond when they have time -- so that coordinating schedules doesn't become an obstacle to collaboration. 

2. Coordinated Care Champions

The author defines this leadership skill as, “encouraging other leaders to think above and beyond the way health care systems are organized today and by leading stakeholders to adopt and build the new coordinated care models of tomorrow.” 

The article says that coordinated care leaders need to be champions for rethinking how we coordinate care around and across the roadblocks of our legacy healthcare system. To us, this makes coordinated care seem like an innovative add-on, rather than a crucial foundation of what it means to care for an individual patient. We believe that no healthcare provider has the option to "skip over" being a master of coordinated care. Coordinating care among a medical team, and at all steps along a medical journey, is simply good patient care. Yes, it helps to have the tools to make that feasible (including Hybrid Store-and-Forward® telemedicine) but we believe no one is exempt. 

3. Trust-based Dyads

This leadership style is described as “redefining and strengthening many critical relationships throughout the health care industry," people who are able to create trusting relationships between medical providers and those in administrative or management positions. The truth is that there is ever-less distinction between these two positions and that everyone on the medical team -- whether traditionally a healthcare provider or not -- is crucial to ensuring that each person is cared for well. Our take? Trust comes from doing important work together, successfully. So having the tools we need to care for our patients -- together -- becomes the way to build that trust and do that work. 

4. Value Evangelists

A value evangelist is seen as someone “guiding their organizations to overcome both the magnitude and pace of change that are required to relentlessly pursue value-based care... and to motivate complex organizations to persevere through change that disrupts established norms and habits.”  We've certainly found this to be the case. There is often one person in each organization that is responsible for the innovation required to improve patient care. The interesting reality, though, is that this person is not always the person at the top of the hierarchy with the highest title and salary level. It may be a social worker, an aide, a new doctor, or a nurse who pioneers a new tool like iClickCare, begins using it herself, and thus becomes a champion for a new way of doing medicine and improving care. 

 

All of these leadership styles and attributes are crucial as we move forward into the new stages of medicine -- and I believe that they're all common across our organizations, very much across the continuum of care. Each minute of each day, we can choose whether and how to embody these principles -- and it's up to us as medical providers. But it also depends on making sure we have the right tools to succeed. 

 

Learn from other leaders in medical collaboration with our Quick Guide: 

 

ClickCare Quick Guide to Medical Collaboration

Can Telemedicine Change Rural Medicine’s Challenges?

Posted by Lawrence Kerr on Wed, Sep 05, 2018 @ 07:00 AM

jan-vernarec-290297-unsplashEveryone in medicine is under financial pressure these days.

For many rural clinics and hospitals, that has meant closing or consolidating. And for people in rural areas, that has meant limited access to care or extremely long drives to receive care. For instance, this article tells the story of a new mom in Missouri who was making regular 200-mile trips to be with her newborn twins in the NICU. Then she’d drive back home to be with her 2-year-old and go to work.

Rural medicine, whether in remote areas or in places like Native American reservations, has always come with its unique joys, gifts, and challenges. But the more medicine evolves, the greater the pressure on these rural providers and hospitals seems to be.

The New York Times reports, “At least 85 rural hospitals — about 5 percent of the country’s total — have closed since 2010.”

One doctor commenting on the article describes the situation from his viewpoint: “The main issue I’ve seen working in health care is consolidation of smaller systems into larger collectives. Smaller rural hospitals are bought by the larger systems, which in turn buy out practices, and end up owning everything in a three to five county radius — sometimes more. The system shunts patients to their main facilities and either closes or cuts back on services offered at the smaller hospitals. It’s not surprising, because it is a balancing of limited resources in a for-profit system, but it does leave the most vulnerable without access to care.”

Certainly, these pressures are a reality. And many providers and patients are dealing with that reality on a daily basis. But these articles also led us to wonder whether there are other solutions to these challenges, beyond the 200-mile drive to care for a newborn.

We’ve worked with many providers, clinics, and hospitals in remote areas who find that by using telemedicine, they’re able to dramatically expand their offerings and capabilities, while decreasing costs.

For instance, with hybrid store-and-forward telemedicine, even a more bare-bones staff is able to get consults on cases that they’d normally have to send to a much larger care center, many hours away. Furthermore, the staff is able to coordinate care for patients so that they may be able to avoid unnecessary visits to distant centers.

So although telemedicine can't fix everything  a woman in labor still usually needs a maternity ward that's closer than 100 miles from her home  there are creative ways of working within these new constraints. And telemedicine, care coordination, and medical collaboration are three tools that may help. 

To learn more about hybrid store-and-forward telemedicine and how it can help in rural settings, download our free guide:

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: rural medicine, telemedicine solutions, hybrid store and forward medical collaboration

5 Things John McCain Taught us About Courage and Medicine

Posted by Lawrence Kerr on Thu, Aug 30, 2018 @ 07:00 AM

jacob-stone-560933-unsplashAs you undoubtedly know, Senator John McCain died last weekend at his home in Arizona. 

While he wasn't a healthcare provider, and while we certainly weren't in agreement with every political stance he took, we found his life and principles an inspiring example of leadership and courage. In these challenge years in the medical system, that example of courage feels more relevant than ever for our lives as healthcare providers.

Son of military parents himself, a young John McCain moved frequently as a child -- attending more than 20 schools in his childhood. He went to the United States Naval Academy in Annapolis, Maryland but generally resisted conformity and showed an intense streak of independence and irreverence. It seems that his youthful adventuring became more focused and purpose-driven as he racked up years in the Navy. He flew 23 missions in Vietnam.

Then, perhaps the most famous episode of his life occurred. As a Navy lieutenant commander pilot, he was shot down over Vietnam and endured 5 and a half years of captivity, torture, starvation, and manipulation. 

Of course, he went on to serve two terms in the House of Representatives and six terms in the Senate. And then this past weekend, he died from the glioblastoma he had been receiving treatment for since 2017.

 

5 Things John McCain Taught Us About Courage and Medicine:

  • Don't let hard times be the end of the story. 
    I find it inspiring to think about how the young man who was shot down over Vietnam, and tortured and starved for more than 5 years, had no way of knowing how much was in store for him across his life. Ultimately, McCain didn't let his imprisonment and torture be the end of the story, just as so many healthcare providers must choose to make their personal or professional challenges be just the beginning of the story as well. 
  • Be independent. 
    Although Mr. McCain was a Republican, his voting record and stance on the issues tended to show an incredible amount of independence. Far from swayed by trends or expediency, McCain seemed to hew to what he saw as right. While few of us are voting in the halls of Congress, I believe that we're often pressured and even swayed by politics, trends, or habit. McCain's shining example of independence of thought (even if not always perfectly executed) is one we can all learn from. 
  • Let courage take precedence over self-interest. 
    As the New York Times reports, "At some McCain rallies, vitriolic crowds disparaged black people and Muslims, and when a woman said she did not trust Mr. Obama because 'he’s an Arab,' Mr. McCain, in one of the most lauded moments of his campaign, replied: 'No, ma’am. He’s a decent family man, a citizen that I just happen to have disagreements with on fundamental issues.'" Many of us have the opportunity to do what's right, even when it seems impractical in the short term. This episode shows me how important that is, even when it seems like so much is on the line.
  • Perfection isn't required. 
    The reality is that John McCain sometimes acted inconsistently, sometimes let his temper get the better of him, and sometimes found himself on the wrong side of history in voting. And honestly -- this is part of his reality that inspires me. Perfection isn't required for leadership or for courage. What's required is standing up each day, accepting the reality of what you've been giving, and acting from your principles to the best of your ability. 
  • Collaborate with those who are different from you. 
    We talk frequently about the value of healthcare collaboration, especially across the continuum of care, with those who may have different perspectives than you have. McCain is known for being a core part of the Gang of Eight in Obama's presidency, a bipartisan group of Senators working towards comprehensive immigration reform. As McCain said, “I encourage my colleagues on both sides of the aisle to trust each other, stop the political gamesmanship and put healthcare needs of the American people first. We can do this.” 

Just as Mr. McCain spoke to President Obama's character in a high-pressure situation in the campaign, Mr. Obama released a statement on Saturday saying, "Few of us have been tested the way John once was, or required to show the kind of courage that he did. But all of us can aspire to the courage to put the greater good above our own. At John’s best, he showed us what that means.”

Just one more piece of evidence that courage and integrity breeds more courage and more integrity. A reminder that everyone in medicine can use. And as ever, McCain doesn't let us off the hook. As he said in 1993, “My time is slipping by. Yours is fast approaching. You will know where your duty lies. You will know.”

 

ClickCare Quick Guide to Hybrid Store-and-Forward

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